Spinal Paraganglioma — SCE Neurology MCQ

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HardNeuro-oncologySpinal ParagangliomaSCE Neurology

A 50-year-old man presents with progressive bilateral leg weakness, back pain, and bladder dysfunction over 8 weeks. MRI spine shows an intradural extramedullary mass at T12 with a mottled 'salt and pepper' appearance and prominent flow voids. The lesion is highly vascular on catheter angiography. What is the most likely diagnosis?

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Correct answer: D — Paraganglioma (spinal)

Spinal paragangliomas are rare, highly vascular intradural extramedullary tumours that typically arise in the cauda equina/filum terminale region. MRI shows a 'salt and pepper' appearance (due to flow voids from vascularity and areas of haemorrhage/signal heterogeneity). They are intensely enhancing and hypervascular on angiography. Treatment is surgical resection with preoperative embolisation to reduce intraoperative bleeding. A: Schwannomas are typically homogeneously enhancing without prominent flow voids. B: Meningiomas enhance homogeneously. D: Ependymomas are usually intramedullary. E: Lipomas follow fat signal on all sequences.

Reference: NICE NG99; WHO CNS Tumour Classification